Tag Archives: MRI

What I Learned about the Future of Breast Cancer Detection from Joining a Clinical Trial

16 Jun
Helping other women lets me get in touch with my inner goddess (thank you, Wikimedia Commons and the ancient Minoan culture!)

Helping other women lets me get in touch with my inner goddess (thank you, Wikimedia Commons and the ancient Minoan culture!)

Because I just love living dangerously, I am a card-carrying member of the Sloan-Kettering Special Surveillance Program for women who are at a high risk of breast cancer. That means that every six months, as I did yesterday, I pop in to the famous cancer hospital for a mammo or an MRI and a little hands-on quality time with the wonderful Dr. Mangino who runs the program. I call it my Semi-Annual Sloan-Kettering Day of Beauty.  I’m lucky, because I still don’t actually have cancer. And anyway, today I want to tell a happy story. It’s a story about how I got to see the future of medicine.

One of the benefits of being an “interesting” patient who has the good luck to be treated at a teaching hospital is that I have the opportunity to be asked to participate in clinical trials. Last winter, before I went to my last S-K day of beauty, I was asked if I would, in addition to getting my usual MRI, get a special kind of mammogram for this study:

https://clinicaltrials.gov/ct2/show/NCT01716247

“Comparison of Contrast Enhanced Mammography to Breast MRI in Screening Patients at Increased Risk for Breast Cancer.”

According to the information provided by Sloan-Kettering via the National Institutes of Health, the purpose of the study is “to determine if Contrast Enhanced Spectral Mammography (CESM) will be able to detect smaller/earlier breast cancers as well as breast MRI can.”

What that meant was that instead of just having a plain mammogram, I had an IV needle placed in my hand filled with a special dye. As it circulated into my breasts, it made the contrast between different types of tissue clearer.

Honestly, except for the slight annoyance of the initial pinprick and the tangle of the IV line, it wasn’t a big deal at all. And after it was over, a young scientist working on the study spent time talking to me and showing me some of the preliminary results of the study. He showed me pictures of regular mammograms and contrast-guided mammograms. The results were remarkably different. It looked as if the different areas of tissue were limned in dark gray in the contrast-guided mammos, whereas the regular ones looked much more pale and indistinct. I felt sorry for radiologists who had the terrifying—but boring-looking—job of trying to find suspicious pieces of matter on such a vague field of off white. It looked very easy to miss a cancerous lump in such cases. After I saw that result last winter, I went home feeling very pleased that I had been part of something bigger, something that might be useful someday.

And yesterday, I was even more pleased, because the lovely Dr. Mangino told me that the next time I came, I would be getting a contrast-dye mammogram for real. “The study results are looking great,” she said. “I wasn’t convinced at first. But I’m impressed.” At the front desk, the young receptionist told me that Sloan-Kettering is still one of the few places—if not the only place—in the nation where contrast-enhanced mammograms are done. Yet. But if they’re as good as they look as if they are, they’ll be coming. And when they do, they’ll save lives. And I’ll know I did at least a tiny little bit to help.

Do you have any interest in joining a clinical trial of any sort? You can find out more at ClinicalTrials.gov.

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Dudes! Ladies! Listen up: DO NOT GET A TATTOO!!!!!

20 Oct

First of all, my friends, if you already have a tattoo, I LOOOOOOVVVE it. It looks so good on YOU! Don’t change a thing! You’re adorable! Many of my dearest and most brilliant friends display examples the ancient art of tattooing. I appreciate its venerable past and that special combination of rebelliousness and search for beauty that it conjures up. . And I also know, my friends, that you are the owners of your bodies and the captains of your souls.

However, if you do not have a tattoo, and yes, I am speaking to a certain 18-year-old with purple hair and a lip ring who shall remain nameless, among others, DO NOT GET ONE. THEY ARE NOT SAFE.

Yes, there are awkward situations with tattoos and job interviews—perhaps less than there used to be, but nonetheless, moments when perhaps the strapless gown seems like a bad idea or perhaps the longsleeved shirt would be a wiser choice than the tank top even if it’s 110 degrees. Or those “I love Winona” Fails. Or, the really spiritual Hindu word—or so you think—that turns out to mean something very different. I know there are those who think it’s utterly implausible that anyone would EVER be judged on their looks, but anyone who has ever picked up a People Magazine and seen stars constantly being chided for either being too frumpy or too slutty might feel differently. Was Kate Middleton’s dress “too much”? Or “not enough.” It’s a fine line, young Padewan.

My main two problems with tattooing are as follows. One is serious, one is not. Naturally, I will go with the deeply unserious one first.

  1. 1.    Lack of master planning.

Tattooing often seems to go hand in hand with that lighthearted spirit of individuality that makes one so deeply alive to the moment and the excitement of getting Jesus on a skateboard dressed in an American flag and sunglasses emblazoned on one’s chest that one forgets that one might later want to turn to another, deeply unrelated theme. Perhaps you will go through an Incan phase later, or just want a delicate little rose on your left buttock cheek or a dragon—how could I leave out dragons? Or “In Memory of Hector” all across your back (seriously, one definitely gets an education on body art going to a Waterpark).  Or the rolling ship on the stomach, or the Yin and Yang symbol or what have you. Let’s face it, We Contain Multitudes. Who knows what might seem like a good idea once you’ve got Jesus in the American Flag taken care of. But the problem is, Fashionistas, and I hope you will appreciate the full horror of this sentence: Your. Outfit. Will. Not. Match.  Do I need to repeat this?

  1. Okay, there are three problems. Tattoos get real old, real fast

Look in your closet. Or better yet, look in your mother’s closet. Does she have some really old dresses with giant shoulderpads? Hello, 1980s. Guess what she can do? Stuff them in a bag and palm them off on Goodwill. And then buy new ones. But for you, fashion will always be frozen in 2012. Your outfit, the one you will always have on if you catch my drift,  the one that’s going to be slowly migrating south over the years and shriveling like a Granny Apple left on the windowsill for a month, will NEVER change. Groovy!

3. But let me get to the real problem: TATTOOS ARE NOT SAFE!!!

Yes, there are reputable tattooists. They use clean needles. They sanitize everything. You could eat off their chairs. Their hearts are as pure as a mountain spring and their talent is a divine wellspring. They aren’t the bad tattooists who spread HIV and Hepatitis C. But as sterilized as the best tattooists are, they cannot environment is, they cannot promise you that the ink is safe. Because the FDA does not regulate tattoo ink. That lathering of Ivory Soap that glides right off your skin with a splash of water has been tested on thousands of hapless lab rats. That ink you want to inject deep into your skin contains whatever the hell is lying around in the inkmaker’s den. Some of the substances found in tattoo ink include antifreeze, mercury, lead, car paint, and dirty water containing mold and bacteria. In fact,, a new outbreak of disease caused by a bacteria called nontuberculous Mycobacteria (NTM) has been linked to a recent outbreak from contaminated tattoo inks. According to the FDA, these bacteria can cause a number of dangerous organ infections, including lung disease, eye disease, and others. They’re hard to spot. You need a specialist who can understand the nature of the papules—yeah, you really want papules, right/ That sounds good—that are symptomatic of NTM infections.

That’s not the only problem. If you need an MRI, a tattoo that contains metal (sometimes used in eyelining, but possibly in other tattoos as well) can burn you as MRIs are magnetic. Many people get rashes—some of them that stay for years—from tattoos. And trying to remove tattoos is extremely expensive and stirs up carcinogens. So for the 50 percent of people who regret getting tattoos, there can be more danger in removing them than letting them lie.

So, my friends—especially that purple-haired one with the lip ring—get that Skateboarding Jesus if you must. But don’t do it without weighing not just the you of today, but the you of the rest of your whole life. Because that sucker is going to be with you for a long, long time.

Writing Spark: Best and worst tattoos ever?????? Would you get one? Do you have one? Are you glad you have it? Would you do it again???

Resources:

Tattoo Ink–Related Infections — Awareness, Diagnosis, Reporting, and Prevention (New England Journal of Medicine)

http://www.nejm.org/doi/full/10.1056/NEJMp1206063

 

The Dangerous Art of the Tattoo http://health.usnews.com/health-news/family-health/articles/2008/07/25/the-dangerous-art-of-the-tattoo?page=2

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm316357.htm

Tattoo Inks Pose Health Risks

http://www.webmd.com/skin-problems-and-treatments/news/20120822/studies-question-safety-tattoo-ink

Sloan Ranger

9 Oct

This is breast cancer awareness month and don’t think I don’t know it. Today is my Memorial Sloan-Kettering Day of Beauty. I will get an MRI and an exam as from the lovely Dr. Mangino, head of the Special Surveillance center for high risk patients.  Don’t get me wrong. It’s a very nice place. They get it. They have a beautiful modern building, a seat on the elevator, and snacks! Oh yeah—and so far, I haven’t had breast cancer!! But I have had Atypical Ductal Hyperplasia several times, and I’ve had enough surgical biopsies that if I ever cheat on my husband, my partner in infidelity is going to think I spent my former life as a not-very-good pirate who got in a LOT of duels. You should see the other guy ha ha ha.

Anybody who has read the book Brightsided by Barbara Ehrenreich knows that breast cancer is a disease that gets a way-disproportionate amount of funding, but is also probably a cash cow for companies who want to sell anything pink. And it’s also a disease where people are looking for role models. If you have pancreatic cancer, people don’t expect you to be jumping out of airplanes, kicking your feet up on the beach, cuddling a basket of puppies or doing any of those hyper-enjoyable activities that bring to mind ads for constipation or erectile dysfunction products. But breast cancer, oh no, your job is to inspire everyone else on the planet.

The funny thing is, I have a very dear friend with breast cancer and she actually is one of the most inspiring, positive, interesting people I know. And her loving husband is just as inspiring as she is. They had a big party on their 19th wedding anniversary because they didn’t think she’d make it to her 20th. And now, thanks to her fighting to be in an experimental drug trial and various other things, she’s planning her 25th. So here I am, ruining my storyline.

Anyway, the reason I wanted to write today is that I know that a lot of people are afraid of MRIs, and I want to tell you that there is nothing to be afraid of, and if you ever have the opportunity to have one, here are my tips. (My own dear husband has never had the pleasure.)

Okay, first, you get changed. Take off all your metal items—earrings, etc. You can keep your gold rings. You have to tell them if you have metal inside you (titanium markers or things like that are okay). Because that sucker is magnetic and things will go flying around. Nota bene: If you ever considered having a tattoo with any kind of metallic element—people sometimes do this with tattooed eyeliner for instance—don’t. Because then you can’t have an MRI and you may need one.

Then, you lie on this skinny table. This is the time when you get into your inner zen state. One of the gifts of raising children for me is that they tired me out so much that for the rest of my life, whenever I lie down, I can instantly drift off into a dreamlike state. Now here’s my special trick: ASK FOR A BLANKET. They always have blankets, but they don’t always remember to give you one. Sometimes the blankets are heated. Heaven! Sometimes they give you earphones, sometimes they pipe music in if you want it, and in your hand they place a ball to squeeze if you’re in distress. Then, in you go. Now, some people get claustrophobia, My advice is to reframe this thought. Remember in the 1990s or sometime back in the day, they had these special napping places in big cities where you could take the perfect nap for like 20 minutes? To me, that’s what it’s like. It’s your pod. Only, instead of costing $20 or whatever the ridiculousness was, it costs $1000 and you get pretty pictures.

Oh, that reminds me. Sometimes they put in an IV and give you contrast fluids so they can see certain areas. (Sometimes MRIs are WITH contrast, sometimes WITHOUT). The IV is no big deal especially if you ask the nurse questions when he/she is putting it in because I love nurses and they’re all interesting IMHO. Then, when they put the fluid in (usually sometime in the MIDDLE of the MRI—they might take you in and out several times), it may feel a little cold or warm, I can’t remember which. But it’s not a big deal. At certain points, they warn you that it’s going to make some loud noises. It does, but for me, I’m still happy because I lovvvvvvve lying down so much and it’s so much better than fishing pennies out of a two year old’s mouth or toy cars out of a toilet, or, say, work. All you have to do is lie there and think dumdedumdum, sing along with the music in your mind, think about clouds or that super romantic vacation you took on the beach or creative ways your enemies shall come to no good end that you have no hand in causing or whatnot and in about 20-40 minutes it will be over and you will be sad, because you have to rejoin the land of the sitting and standing again. You were all cozy in your little magic pod and now it’s over.

My other piece of advice for MRIs, and this is a big one my friend, is please make sure it is precertified by your insurance company. Or then you will be crying, big time, when you get the bill.

Happy Breast Cancer month! Pink balloons and ribbons and bunnies and bears and NFL mouthguards and cars for all!! XOXO

Writing Spark: What’s a medical procedure you’ve had and would like to explain to others, telling us whether it’s not so bad or worse than you thought.